Blood glucose protocol in LTC facilities

[rnto?]

So, the other day just as I was coming on shift one of the night turn nurses who is both an RN (as am I) and who has been a nurse longer than I've been alive was dealing with a low blood sugar on a patient. I went to the room to help her as the patient was to be mine when she left. She gave him OJ with sugar packets added but before she could get it into him he became unresponsive with a blood glucose of 24. Another RN who is in mgmt. at the facility was also involved. I was the runner person, first getting them the OJ, then glucose gel, then the mgmt. RN decided to start an IV to give an amp of D50, so I ran to get all of that stuff. His glucose came up, he was fine, but the DON was upset because no one called the MD until after the fact. (I had just walked into the situation and deferred to the two much more experienced RNs who were telling me what to get them). She said that if a person becomes hypoglycemic and unresponsive, we are not to do anything without calling the MD. If the MD doesn't answer we are to call the paramedics, but we shouldn't give glucagon or D50 without an MD order. The facility protocol says to give OJ or call the MD if the patient is unresponsive. The night turn RN says that her license would be in jeopardy if she didn't do anything and the patient died before the MD called back or the paramedics got there. I don't know what the laws are on this topic. Any ideas?

[achot chavi]

Agree with you on this one, BM.

Oftentimes, because MD residents are required to do training rotations in all of the facility's units, they end up spending only a few months in ICU / ED or even Telemetry. As such, seasoned unit RNs will out-trump them in experience many times over.

No one is arguing the advantages of a seasoned RN over an MD resident. Its just a matter of protocol and level of responsibilities.

Of course the OP did the right thing and saved the patients life for which everyone is grateful. The DON is just pointing out legal responsibilities and limitations of the RN (seasoned or not).

Ironically BECAUSE we are seasoned RN's, if we mess up or something goes wrong or the patient didn't recover, we have more to lose.

The DON was just looking after her (valued) RN's back , not reprimanding her.

[CoffeeRTC, BSN, RN]

Just remember....this was a question for LTC. Things are so different in the hospital.

Again...why no OJ in the G Tube?

MONdk...what would your doc have wanted you to do?

I do remember part of our orders/ protocol.. Just about everyone has as an order to call md if bs is below 70. I think the protocol is to give a snack when low bs then call md.

Def will check on this when I work next.

[evilolive, BSN, RN]

Couldn't you just pour the OJ in the Gtube?

I had tried that at the beginning of shift when the off going nurse reported that his sugar was low. I gave at least 2 cups of OJ. His sugar continued to run in the 70's to 80's all night... but then during his AM accucheck he was 37! OJ wasn't going to do the trick via the G-tube ...

[Havin' A Party!, ASN, RN]

No one is arguing the advantages of a seasoned RN over an MD resident. Its just a matter of protocol and level of responsibilities...

Don't wanna get off the main track of the thread here, but the comments the above refers to was addressing "life in the ICU," not in LTC. They were merely an aside to the principal discussion.

Just clarifying. :nuke:

[achot chavi]

consider urslf clarified :-)

[Not_A_Hat_Person, RN]

i am going to have to go with the paramedic come back on this one "it is easier to defend a live one than a dead one."

Isn't hypoglycemia considered an emergency if the patient is unresponsive? The DON was technically correct, but the important thing is that the patient lived.

[CapeCodMermaid, RN]

Unfortunately sometimes technicalities are what count.

[morte, LPN, LVN]

would you rather go before the board or in court, if the patient died because you didnt do what you knew how to do?

[CapeCodMermaid, RN]

If you are working within the scope of your practice, and you do what a reasonably prudent person with the same knowledge base does in the same situation, I don't think you'd end up before the BON or in court.